Exam (elaborations)
Saunders NCLEX-RN 7th Study - Renal
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Saunders NCLEX-RN 7th Study - Renal
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STUVIA 2024/2025Saunders NCLEX-RN 7th Study - Renal
1
R: -itis= inflammation/infection, which usually is accompanied by a fever - ✔✔The nurse is providing
instructions regarding the complications of peritoneal dialysis. The nurse emphasizes that onset of
peritonitis, a serious complication, is most likely to be associated with which clinical manifestation?
1. Fever
2. Fatigue
3. Clear dialysate output
4. Leaking around the catheter site
1
R: Bearing down (vagal/vasalva) may increase bleeding from surgical site, and should be avoided.
Option 4 is different bc relaxing the abd muscles prevents the vasalva maneuver. - ✔✔A client who
has had a prostatectomy has been instructed in perineal exercises to gain control of the urinary
sphincter. The nurse determines that the client demonstrates a need for further teaching when he
states that he will perform which movement as part of these exercises?
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1. Bearing down as if having a bowel movement
2. Tightening the muscles as if trying to prevent urination
3. Contracting the abdominal, gluteal, and perineal muscles
4. Tightening the rectal sphincter while relaxing abdominal muscles
1
R: blood may = urethral trauma, so you need to notify the HCP first so you can identify the true cause
of blood before catheterization.
Since there's blood from an unknown cause, you need to assess first before doing anything that can
worsen it. - ✔✔A client is admitted to the emergency department following a fall from a horse and the
health care provider (HCP) prescribes insertion of a urinary catheter. While preparing for the
procedure, the nurse notes blood at the urinary meatus. The nurse should take which action?
1. Notify the HCP before performing the catheterization.
2. Use a small-sized catheter and an anesthetic gel as a lubricant.
3. Administer parenteral pain medication before inserting the catheter.
4. Clean the meatus with soap and water before opening the catheterization kit.
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1
R: CAPD closely approximates normal renal function, and the client will need to infuse and drain the
dialysis solution several times a day. No machinery is used, and CAPD is a manual procedure. -
✔✔The nurse instructs a client about continuous ambulatory peritoneal dialysis (CAPD). Which
statement by the client indicates an accurate understanding of CAPD?
1. "No machinery is involved, and I can pursue my usual activities."
2. "A cycling machine is used, so the risk for infection is minimized."
3. "The drainage system can be used once during the day and a cycling machine for 3 cycles at
night."
4. "A portable hemodialysis machine is used so that I will be able to ambulate during the treatment."
1
R: CKD is a condition in which the kidneys have progressive problems in their ability to clear
nitrogenous waste products and control fluid and electrolyte balance within the body. Conservative
treatment of CKD slows progression of the disease and includes reducing the protein, sodium,
potassium, and phosphorus in the diet and controlling the blood pressure. It is important to reduce the
sodium in the diet. Salt substitutes usually are potassium-based and should not be used by a client
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with CKD because of the risk of hyperkalemia. The client should alter the fluid intake in relation to
urine output. Obtaining a daily weight is an important measurement that indicates fluid volume. The
client should also monitor for signs and symptoms of fluid overload, which could include an increase
in weight, edema, and fluid collection in the lungs. - ✔✔A client has chronic kidney disease (CKD)
that does yet not require dialysis. Which client statement indicates the need for further teaching?
1. "I will reduce the sodium in my diet, and I can use salt substitutes to spice my food."
2. "The amount of fluid I can have every day depends on the amount of urine I put out."
3. "I will weigh myself on my bathroom scale every morning right after I have urinated."
4. "I should report a gain in weight, trouble with my breathing, or increased leg swelling."
1
R: Clients who form uric acid calculi should be placed on a low-purine diet. Their intake of fish and
meats (especially organ meats) should be restricted. Dietary modifications also may help adjust
urinary pH so that stone formation is inhibited. Depending on health care provider prescription, the
urine may be alkalinized by increasing the intake of bicarbonates or acidified by drinking cranberry,
plum, or prune juice. - ✔✔A client with uric acid calculi is placed on a low-purine diet. The nurse
instructs the client to restrict the intake of which food?
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1. Fish
2. Plum juice
3. Fruit juice
4. Cranberries
1
R: Clients with peritoneal dialysis catheters are at high risk for infection. A wet dressing is a conduit
for bacteria to reach the catheter insertion site. The nurse ensures that the dressing is kept dry at all
times. Reinforcing the dressing is not a safe practice to prevent infection in this circumstance.
Flushing the catheter is not indicated. Scrubbing the catheter with povidone-iodine is done at the time
of connection or disconnection of peritoneal dialysis. - ✔✔The client with chronic kidney disease has
an indwelling abdominal catheter for peritoneal dialysis. The client spills water on the catheter
dressing while bathing. Which action should the nurse immediately take?
1. Change the dressing.
2. Reinforce the dressing.
3. Flush the peritoneal dialysis catheter.
4. Scrub the catheter with povidone-iodine.
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1
R: Cloudy = peritonitis - ✔✔Which finding noted in the client on continuous ambulatory peritoneal
dialysis (CAPD) should be reported to the health care provider (HCP)?
1. Cloudy yellow dialysate output
2. Client refusal to take the stool softener
3. Previous evening's dwell time of 8 hours
4. Peritoneal catheter site is not red, and the skin has grown around the cuff
1
R: Creat is increased only by kidney dysfunction of at least 50% loss. 2&3 are irrelevant. 4 is more
involved w/ UTIs. - ✔✔The nurse is reviewing a client's record and notes that the health care
provider has documented that the client has chronic renal disease. On review of the laboratory
results, the nurse most likely would expect to note which finding?
1. Elevated creatinine level
2. Decreased hemoglobin level
3. Decreased red blood cell count
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4. Increased number of white blood cells in the urine
1
R: Eliminate options 2, 3, and 4 because pink-tinged urine, urinary frequency, and burning with
urination are normal findings after a cystoscopy. - ✔✔The nurse is caring for a client who has just
returned from having a cystoscopy. The nurse should recognize which as an abnormal assessment
finding for this client?
1. The nurse notes bright red urine output.
2. The nurse notes pink-tinged urine output.
3. The client reports having urinary frequency.
4. The client complains of burning when urinating.
1
R: Hyperkalemia & hypocalcemia are both life-threatening complications. All the other options may
not be entirely relevant. - ✔✔Before providing care for a client in the late stages of chronic kidney
disease (CKD), the nurse should review the results of which most relevant laboratory studies?
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1. Serum potassium, serum calcium
2. Urinalysis, hematocrit, hemoglobin
3. Culture and sensitivity testing, serum sodium
4. Urine specific gravity, intravenous pyelogram
1
R: If the bladder irrigation solution is infusing at a sufficient rate, the urinary drainage will be pale pink.
A dark pink color (sometimes referred to as punch-colored) indicates that the speed of the irrigation
should be increased. Bright red bleeding and red urine with clots should be reported to the surgeon
because either finding could indicate complications. - ✔✔The nurse is assessing a client who has
returned from the postanesthesia care unit after transurethral resection of the prostate (TURP). The
nurse should assess for which color in the urinary drainage tubing that indicates proper irrigation and
adequate functioning of the device?
1. Pale pink
2. Dark pink
3. Bright red
4. Red with clots
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